Claims Examiner - Perm

To analyze complex or technically difficult claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES:

• Analyzes and manages complex or technically difficult claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.

• Assesses liability and resolves claims within evaluation.

• Negotiates settlement of claims within designated authority.

• Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.

• In-depth knowledge of appropriate insurance principles and laws for line of business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedure as applicable to line of business

• Excellent oral and written communication, including presentation skills

• PC literate, including Microsoft Office products

• Analytical and interpretive skills

• Strong organizational skills

• Good interpersonal skills

• Excellent negotiation skills

• Ability to work in a team environment

• Ability to meet or exceed Service Expectations

EXPERIENCE:

Four (4) years of claims management experience or equivalent combination of education and experience required.

Education:

Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.